You are here

Forum topic

Our I.C.U is wanting to stop using Heparin flush in central linesÂ Â Actually, I think they have stopped long ago but want to make our hospital wide policy on care of central lines match what we are really doing. Â They are asking me ( picc line nurse) for info .Â I realize the reason for this is to prevent or decrease H.I.T.Â

Â I have seen many ports that are not flushed with heparin clot off and have some concern about this. (even a port that is actively used while a pt is in the hospital).Â I also see that the manufacturer of these devices (ports/piccs/triple lumens) Â still recommends the flushing of saline and heparin for these non valved devices.Â Â

How has this been handled in your instituions?Â I know some have said they use the positive displacement caps on the lines to decrease the risk of reflux of blood on these open ended ( non valved) lines, and are flushing with saline only.Â Â

Is there any issue with going differently than the Â manufacture recommends?Â

They are also saying many times if a patient comes in with a line from elsewhere how do they know it is valved or not. Of course I say it needs to be investigated and identified so proper care in deliverd.Â

Last year, I gave 3 webinars for INS that addresses all of these issues. The only way currently that you can eliminate heparin is to use a needleless connector with saline only instructions for use. However studies are showing that saline only produces rates of occlusion in the range of 6% to 11%. Go to the INS website to locate these webinars and the complete list of references for each.

You will not necessarily be going against manufacturer's instructions for use if you eliminate the use of heparin. There are many open ended central lines and PICC lines that do not specifically state the need for a heparin flush. Many now state you may flush with NS, heparin or per your hospital protocol. Check with your manufacturer.

There are many valves (end caps) on the market currently that can be used with NS only, both positive displacement and neutral displacement. These are FDA approved for NS only. Using a valve/cap with this indication is very effective with all central lines, including open ended CVCs and PICCs.

Investigate other HCA facilities that have transitioned heparin free. I still work PRN at one of them. My concern is port's frequently get caught in this "blanket" coverage. Port flushing protocols need to be seperated out and then depending if port catheter is valved or not. As always, each patients needs should be individualized and may possibly require heparin. PICC/CVC IFU's that include heparin are how they are approved and recommended by manufacturer. A catheter that is indicated and approved for saline flushing only due to a valve (i.e.SOLO) is ideal to cross the continuum of care no matter what connector each provider utilizes.

In the previous 2 messages, the authors used the phrase "approved by the FDA". This phrase could be interpreted by some to mean that there is some level of clinical performance that these products must meet before they are sold in the US. This is not a correct interpretation. In fact, the FDA does not use this word "approved". Most all devices especially the add-on needleless connectors and catheters being discussed come to the US market under the 510K process, which means that the product must prove substantial equivalence to a similar product already on the market. So there are no clinical performance data or evidence that must be presented to the FDA in the 510K process. All the FDA is doing is clearing these products for the US market or simply giving permission to the manufacturer that it is acceptable to sell their product. Gathering and analyzing data on the clinical performance comes when the product is being used clinically, which is after all the FDA clearance processes. So there is no "approval" of these devices.